Provider Demographics
NPI:1669030979
Name:VELASQUEZ, ANGELA PATRICIA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:PATRICIA
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 RIALTO BLVD APT 6213
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-0063
Mailing Address - Country:US
Mailing Address - Phone:512-720-1323
Mailing Address - Fax:
Practice Address - Street 1:6601 RIALTO BLVD APT 6213
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-0063
Practice Address - Country:US
Practice Address - Phone:512-720-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1143824335122300000X
126900000X, 126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
No122300000XDental ProvidersDentist
No126900000XDental ProvidersDental Laboratory Technician